Provider Demographics
NPI:1205983111
Name:FORENSIC TESTING SERVICES, LLC
Entity type:Organization
Organization Name:FORENSIC TESTING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROEKHOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-882-9440
Mailing Address - Street 1:630 N PRINCE LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-6303
Mailing Address - Country:US
Mailing Address - Phone:417-882-9440
Mailing Address - Fax:417-882-9441
Practice Address - Street 1:630 N PRINCE LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-6303
Practice Address - Country:US
Practice Address - Phone:417-882-9440
Practice Address - Fax:417-882-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5385100001332BX2000X, 332B00000X
332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626310007Medicaid
MO626310007Medicaid